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Ornge anticipates that it will have approval from the Federal Aviation Authority by April 1 to enter U.S. airspace, according to an internal memo obtained by The Globe and Mail. As an interim measure, the memo says, Ornge is transporting patients by helicopter to the nearest helipad on the Canadian side of the border, and then taking them by U.S.-based land ambulance to hospitals in Detroit, Buffalo and Rochester, N.Y.

The latest setback at Ornge came as news to Health Minister Deb Matthews, who only learned about the lack of approval on Tuesday, when she was asked about it during Question Period.

Elizabeth Witmer, the Progressive Conservatives’ health critic, who obtained a copy of the briefing document, said patient safety is at risk if the helicopters cannot fly to an American destination.

“It is an issue of life and death in some situations when you have an emergency,” Ms. Witmer told reporters.

James MacDonald, a spokesman for Ornge, said in a statement that requests to transport patients by helicopter to the United States are rare. Only one patient was transferred during a 10-month period ending Jan. 31, he said.

Sources said Ornge at one time transferred one patient a month on average to the United States by helicopter. These were typically high-risk expectant mothers, who must fly at lower altitudes, and burn patients, the sources said. But more recently, the sources said, Ornge has used land ambulances to transfer some patients from helipads near the border to Buffalo and Detroit.

The helicopters are the same aircraft at the centre of controversy over their flawed medical interiors, which position patients too close to the ceiling, making it difficult for paramedics to perform life-saving CPR. Canada’s transport regulator has approved a temporary fix, which involves rotating the pedestal for the stretcher to give medics more space above the patient.

Ornge spent $148-million buying a new fleet of 12 helicopters and is in the process of taking over a lucrative contract to operate the province’s air-ambulance helicopter service. Canadian Helicopters, the country’s largest helicopter company, generated annual revenue of $30-million from the contract.

Ornge also purchased a fleet of 10 airplanes, which operate from Northern Ontario bases in Timmins, Thunder Bay and Sioux Lookout. Six of the airplanes have approval from the aviation authority to fly over U.S. airspace.

The purchase of the aircraft transformed Ornge from a government-funded entity that managed all aspects of the province’s air ambulance service into a transport company.

It remains unclear when exactly Ornge received an operating certificate from Transport Canada to operate the helicopters in Ontario.

Ornge spokesman James MacDonald said in an email late Tuesday afternoon that officials applied to the U.S. regulator for an operating certificate as soon as it was able to do so, which he said was immediately after it received the go-ahead from Transport Canada on Jan. 26.

According to an internal Ornge e-mail obtained by The Globe late Tuesday evening, the air carrier received the operating certificate more than a month earlier. Rick Potter, Ornge’s head of aviation, says in an email dated Dec. 21 that he is “proud” to announce that Ornge received its operating certificate.

“This was an incredible effort from a remarkable team and they achieved the operating certificate in an exceptionally compressed timeframe,” Mr. Potter says.

Mr. Potter could not be reached Tuesday evening to clarify the dates, said Ornge spokeswoman Jennifer Tracey. She said the initial date of Jan. 26 was a “typo” and should have said Jan. 6.

The briefing document says Ornge notified the ministry on Feb. 24 that the helicopters are not allowed to transport patients to the United States. “Ornge claims there is a delay in receiving the necessary FAA approvals,” the note says.

Ornge has dominated the daily Question Period, with both opposition parties calling for Ms. Matthews to resign.

“With each passing day, it becomes more apparent that the minister does not know what is happening at Ornge and that public confidence in her ability to provide oversight is eroding,” Ms. Witmer said in Question Period.

“I can’t possibly know about every detail,” a defensive-sounding Ms. Matthews told reporters. She added that the inability to fly over the United States has had no impact on patient care “whatsoever.”

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